Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm? (with video).

Abstract

BACKGROUND:

Benign biliary strictures (BBS) are usually managed with plastic stents, whereas placement of uncovered metallic stents has been associated with failure related to mucosal hyperplasia.

OBJECTIVE:

We analyzed the efficacy and safety of temporary placement of a covered self-expanding metal stent (CSEMS) in BBS.

DESIGN:

Patients with BBS received temporary placement of CSEMSs until adequate drainage was achieved; confirmed by resolution of symptoms, normalization of liver function tests, and imaging.

SETTING:

Tertiary-care center with long-standing experience with CSEMSs.

PATIENTS:

Seventy-nine patients with BBS secondary to chronic pancreatitis (32), calculi (24), liver transplant (16), postoperative biliary repair (3), autoimmune pancreatitis (3), and primary sclerosing cholangitis (1).

INTERVENTION:

ERCP with temporary CSEMS placement. Removal of CSEMSs was performed with a snare or a rat-tooth forceps.

MAIN OUTCOME MEASUREMENTS:

End points were efficacy, morbidity, and clinical response.

RESULTS:

CSEMSs were removed from 65 patients. Resolution of the BBS was confirmed in 59 of 65 patients (90%) after a median follow-up of 12 months after removal (range 3-26 months). If patients who were lost to follow-up, developed cancer, or expired were considered failures, then an intent-to-treat global success rate of 59 of 79 (75%) was obtained. Complications associated with placement included 3 post-ERCP pancreatitis (4%), 1 postsphincterotomy bleed (1%), and 2 pain that required CSEMS removal (2%). In 11 patients (14%), the CSEMS migrated. In 1 patient, CSEMS removal was complicated by a bile leak that was successfully managed with plastic stents.

LIMITATION:

Pilot study from a single center.

CONCLUSIONS:

Temporary CSEMS placement in patients with BBS offers a potential alternative to surgery.

• Authors: Michel Kahaleh, Brian Behm, Bridger W Clarke, Andrew Brock, Vanessa M Shami, Sarah A De La Rue, Vinay Sundaram, Jeffrey Tokar, Reid B Adams, Paul Yeaton
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 67 Issue 3 Pg. 446-54 (Mar 2008) ISSN: 0016-5107 [Print] United States
• PMID: 18294506 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Coated Materials, Biocompatible
• Metals

Topics

• Adult
• Aged
• Aged, 80 and over
• Cholestasis (etiology, surgery)
• Coated Materials, Biocompatible
• Cohort Studies
• Device Removal
• Equipment Design
• Female
• Humans
• Male
• Metals
• Middle Aged
• Pilot Projects
• Prosthesis Implantation
• Stents
• Time Factors
• Treatment Outcome